The publication of a study discussing the risks that older seniors face when undergoing major surgery has prompted a conversation among clinicians on whether such risks outweigh the potential benefits.

While such choices will be unique for each patient based on their current health status, physicians can help guide them in deciding for or against surgery by discussing its possible outcomes and presenting alternative, less-risky treatments as an option.

 

Troubling statistics

According to a research article published by JAMA Surgery, nearly 1 in 7 older adults die within a year of undergoing major surgery.

Gill TM, Vander Wyk B, Leo-Summers L, et al. Population-based estimates of 1-year mortality after major surgery among community-living older us adults. JAMA Surgery. 2022;157(12):e225155.

The older the patients were, the higher the risks they faced, with patients over the age of 90 being six times more likely to die than those between the ages of 65 to 69.

 

This study also showed that 1 in 3 older adults did not return to their baseline level of functioning at 6 months after major surgery.

In addition, major surgeries tend to greatly affect older patients who already have other health complications. For example, 33% of patients who suffer from dementia die within a year of having major surgery.

This research is especially pertinent since surgeries on patients who are older than 65 make up 40% of the surgeries done in the US.

Geriatric surgery verification. American College of Surgeons.

 

 

What are the risks?

There are many risks associated with major surgery, especially for older seniors. These include (but are not limited to) developing disability from the surgery, worsened quality of life, the inability to live independently, and extended hospitalizations, as well as death, according to a Kaiser Health News article published by CNN.

Graham J. What older Americans need to know before undergoing major surgery. CNN Health. December 27, 2022.

 

Postoperative delirium is particularly common in older patients. It tends to start a few days after surgery, but it will only affect patients for a short time post-surgery.

However, this is an important consideration when discussing surgery with patients, as a person with postoperative delirium will require attentive care after surgery, either from healthcare professionals (HCPs) or loved ones, according to information from the American Society of Anesthesiologists.

Seniors: Surgery risks & anesthesia complications. American Society of Anesthesiologists. 2023.

 

POCD is a more serious condition that can cause memory loss as well as difficulty in thinking and learning, exacerbating such problems if they already exist. Older patients who have conditions such as heart, lung, Alzheimer, or Parkinson’s disease, or who have had a stroke, are at a higher risk of developing POCD.

 

 

Alternatives to surgery

For certain older patients, depending on their health status before surgery and their desired outcome for the procedure, there may be less risky alternatives such as medications, injections, or continued monitoring of symptoms. These can be tried before determining that surgery is needed, per another Kaiser Health News article published by CNN.

Graham J. Research helps seniors make informed decisions about risks, benefits of major surgery. CNN Health. November 25, 2022.

 

 

Facilitating the talk

In the conversations between HCPs and patients about whether or not to have surgery, providing the answers to these questions can be useful:

• What is the goal of this surgery?

• If things go well, what can the patient expect?

• If things don’t go well, what can they expect?

• Given the patient’s health, age, and functional status, what’s the most likely outcome?

• What are the alternatives?

• What can the patient do to prepare themselves?

• What will recovery look like?

Discussing these topics with the patient and their family members in a clear, concise, and empathetic manner may help them understand the potential risks and benefits of undergoing surgery and make a sensible decision based on what’s best for them and their future.